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PubMed1988

[Perforation of the large intestine by a contrast medium enema with barium].

This is a report about five patients who suffered a perforation of the colon during a barium-sulfate enema. In one case, barium leaked into the intraperitoneal cavity causing a barium peritonitis. In the other four cases, leakage into the retroperitoneal cavity occurred. All patients underwent surgical removal and drainage of the barium-sulfate and subsequently required a colostomy. In two cases a bowel resection was additionally performed. In one case the defect re-sutured. Antibiotic therapy was included in all cases. All patients survived the incident and were discharged between 20 days and four months postoperatively. Publications and personal experience led us to manage intraperitoneal or large retroperitoneal perforations by prompt laparotomy with removal of barium and faeces. A proximal colostomy is also required. In smaller retroperitoneal perforations conservative management is feasible, however, if the patient's condition deteriorates, they should be treated as recommended for an intraperitoneal perforation.

Aged↗
PubMedDate not supplied

[Complications of diverticular disease of the colon. Apropos of 247 cases].

In the last five years, 7 teams, members of a surgical club of lower Normandy, have performed 1,136 colon procedures, including 247 for severe diverticular disease. The patients were grouped in two categories according to the severity of the complications presented: 159 sub-acute complications including 137 acute cases of sigmoiditis (diverticulitis, peri-colic micro abscesses, pseudo-tumoral forms) and 22 fistulae, 88 severe acute complications including 60 generalized peritonites, 12 huge abscesses, 9 occlusions and 7 hemorrhages. The total post-operative mortality is 6 p. cent. It is quite different in the surgery of sub-acute complications (0.6%) and the surgery of acute severe complications (16%). The total morbidity reaches 14.8 p. cent. Complications are more frequent and more severe in acute forms (18.5%) than in subacute forms (10.5%). At long term, 10.8 p. cent of the patients operated upon, kept a permanent colostomy (25 p. cent in acute forms vs 2.3 p. cent in subacute forms). 89.2 p. cent have a normal digestive tract following treatment (97.7 p. cent in subacute forms and 53 p. cent in acute forms).

Abscess↗
PubMed1987

The management of inflammatory complications of colonic diverticular disease.

Inflammatory complications of colonic diverticular disease remain a common and dangerous cause for hospital admission in our ageing society. The presentation, pathology, general and surgical management of acute diverticulitis, peritonitis and perforation of colonic diverticular disease are reviewed.

Diverticulitis, Colonic↗
PubMed1987

Colostomy or ileostomy after colorectal anastomosis?: a randomised trial.

Sixty one patients were entered in a randomised trial to compare transverse loop colostomy with loop ileostomy after a colorectal anastomosis thought to be at risk of dehiscence. Radiologically proven breakdown of the colorectal anastomosis occurred in 13% of these selected patients and most frequently in the colostomy group. Ileostomies functioned earlier than colostomies (P less than 0.001) but there was no other significant difference in outcome between the groups. In 52 patients intestinal continuity was restored by excision of the stoma within a month of construction with no difference in morbidity between the two groups. A loop ileostomy, closed as soon as the colorectal anastomosis has healed, is recommended as an alternative to transverse colostomy.

Aged↗
PubMed1987

Treatment of acute femoral neck fractures with total hip arthroplasty.

Between 1973 and 1983, 27 patients with acute femoral neck fractures were treated at the UCLA Medical Center with total hip arthroplasty. These cases were selected on the basis of age, high activity level, and degenerative changes in the acetabular cartilage. The average age was 72 years. There were 19 women and eight men. The average follow-up period was 3.8 years with a range of one to ten years. Methods used included analysis of clinical data, roentgenograms, final pain ratings, walking ratings, and activity levels using the UCLA rating system. Pain relief and overall functional results were better than that of most series of acute femoral neck fractures treated with hemiarthroplasty and similar to that of total hip arthroplasty series. The complication rate was slightly less than both authors' elective total hip series, and considerably less than most hemiarthroplasty series. Complications included a superficial wound infection, a urinary tract infection, and a perforated colon diverticulum. Four patients died within one year from causes unrelated to the hip arthroplasty. There were no deep infections, dislocations, or reoperations. Total hip arthroplasty in selective cases of acute femoral neck fractures can give more consistent pain relief and better functional results than hemiarthroplasty, without an increase in complications.

Acute Disease↗
PubMedDate not supplied

[Natural history of diverticular disease of the colon].

Diverticular disease of the colon is frequent in developed countries, probably due to diets poor in fiber. Prevalence increases with age, reaching 65 percent at 70 years. The preferred seat of the disease is the sigmoid colon. The disease is usually asymptomatic, but inflammatory signs are seen in 10 to 25 percent of cases. Diagnosis of diverticulitis is difficult since correlation between clinical signs and histological data is often mediocre. Surgery is carried out in 15 to 30 percent of patients presenting severe disorders, i.e. in 1 to 2 percent of the overall population presenting diverticulosis of the colon. The most efficacious method of preventing complications may be the implementation of a fiber-rich diet.

Adult↗
PubMed1985

Pathology of the ageing--diverticular disease.

The correlation of increased incidence of diverticular disease with age is well documented. Such a correlation results from the development of a structural change in the taeniae coli, a progressive elastosis. The consequences of this elastosis are a shortening of the taeniae coli and a subsequent change in the circular muscle layer secondary to this. This type of structural alteration takes time to develop and thus explains the time lag experienced between a change in diet and an altered incidence of the disease. Eastwood et al (1982) have suggested that diverticular disease is merely a normal concomitant of ageing which is degenerative in nature. However, the changes in structure in this condition appear to be dynamic, being associated with an altered intraluminal environment. Such a concept is crucial to our understanding of the pathology of ageing in general. Atherogenesis is associated with muscle cell hypertrophy, another dynamic change, which also leads to elastin formation. This suggests that treatment of such conditions should not just be limited to the control of an inevitable deterioration but should be directed to the investigation of the stimuli that may trigger such conditions. For example, it is interesting to speculate exactly when the changes that lead to diverticular disease begin: not only is a high fibre diet eaten in Africa, but breast-feeding may continue until the age of two years. The greatest increase in thickness in the normal colon occurs in this period and it may be that early weaning distorts this proliferation. The initiating factor in the aetiology of elastogenesis could be the small stools produced on a 'Western' diet which only intermittently distend the colon. Arterial smooth muscle cells increase their uptake of elastin precursors (particularly proline) when subjected to intermittent distension (Leung et al, 1976) and this may form a common link in the changes generated in vascular and colonic muscle tissue with time. This type of change is independent of alterations in motility and thus explains why asymptomatic patients have a normal motility index (Weinreich and Anderson, 1976). The muscular thickening in uncomplicated diverticular disease can therefore be explained in terms of elastosis and contracture of the taeniae coli in the presence of normal muscle cells. This does not exclude the possibility that hypertrophy and hyperplasia of these cells can develop in response to subsequent pericolic inflammation and fibrosis.

Age Factors↗